What is collarbone surgery. How long does it take to recover from a broken collarbone. What are the risks associated with collarbone surgery. When is collarbone surgery necessary. How is collarbone surgery performed. What is the healing process after collarbone surgery. How can physical therapy aid in recovery from collarbone surgery.

Understanding Collarbone Fractures and Their Treatment

The clavicle, commonly known as the collarbone, plays a crucial role in supporting shoulder movement. Collarbone fractures are relatively common, accounting for about 5% of all adult fractures and 35-45% of breaks in the shoulder area. These fractures often result from falls onto the shoulder or an outstretched arm.

Collarbone fractures can occur in three main locations:

• The middle of the collarbone (most common)
• Near the acromioclavicular (AC) joint, where the clavicle meets the shoulder (second most common)
• Close to the sternum (least common)

The severity of the fracture determines the need for surgery. In some cases, conservative treatment without surgery may suffice. However, more severe fractures often require surgical intervention to ensure proper healing and alignment.

When Is Collarbone Surgery Necessary?

Doctors may recommend collarbone surgery in several situations:

• Displaced fractures: When the bone breaks and becomes significantly misaligned
• Open fractures: When the broken bone pierces through the skin, increasing the risk of infection
• Non-healing fractures: When conservative treatments fail to heal the fracture properly

Approximately 30% of collarbone fractures treated without surgery do not heal properly, potentially necessitating surgical intervention.

The Collarbone Surgery Procedure: What to Expect

Collarbone surgery typically involves a procedure known as Open Reduction and Internal Fixation (ORIF). This surgery aims to realign the misplaced bones and fix them in place using screws, pins, plates, or rods.

The ORIF procedure generally follows these steps:

1. Administration of general anesthesia
2. Application of antiseptic to the skin area to prevent infection
3. Making an incision in the skin and muscle near the collarbone
4. Aligning and repositioning the broken bone pieces
5. Inserting plates, screws, or pins to hold the bones in place and improve shoulder strength

Preparing for Collarbone Surgery: Essential Steps

Before undergoing collarbone surgery, patients receive specific instructions from their healthcare providers. These may include:

• Temporarily stopping certain medications (only as directed by a healthcare professional)
• Undergoing X-rays to determine the severity of bone misalignment
• Completing blood tests and an EKG to ensure safe operation

It’s crucial to follow these instructions carefully to ensure the best possible outcome from the surgery.

Recovery and Healing Time After Collarbone Surgery

The healing time following collarbone surgery can vary depending on individual factors such as overall health and lifestyle habits. However, most people can resume regular activities approximately three months after the surgery.

During the initial recovery period, patients will need to wear a sling to immobilize the shoulder. Some pain is expected as part of the natural healing process, and healthcare providers will advise on appropriate pain management strategies.

How long does it take for a surgically repaired collarbone to heal completely? While most patients can return to normal activities within three months, complete healing and bone remodeling can take up to a year. During this time, patients may experience gradual improvements in strength and range of motion.

Potential Side Effects and Sensations During Recovery

Patients may experience some common side effects during the recovery process:

• Numbness in a small patch of skin below the incision site (may become less noticeable over time)
• Sensation of feeling the plate that holds the bones in place
• Temporary limitations in shoulder movement and strength

The Role of Physical Therapy in Collarbone Surgery Recovery

Physical therapy plays a crucial role in the recovery process following collarbone surgery. After an initial period of healing, healthcare professionals often recommend physical therapy to aid in rehabilitation.

How can physical therapy benefit collarbone surgery recovery? Physical therapists can assist patients by:

• Teaching exercises to improve range of motion
• Developing strength-building routines for the shoulder
• Providing guidance on proper posture and movement to prevent re-injury
• Offering manual therapy techniques to reduce pain and improve mobility

Regular physical therapy sessions, combined with at-home exercises, can significantly enhance the recovery process and help patients regain full function of their shoulder more quickly.

Risks and Potential Complications of Collarbone Surgery

While collarbone surgery generally has good outcomes, it’s important to be aware of potential risks and complications:

• Infection at the surgical site
• Bleeding or blood clot formation
• Nerve or blood vessel damage
• Nonunion or malunion of the fracture
• Hardware problems (e.g., loosening or irritation from plates or screws)
• Shoulder stiffness or reduced range of motion

What steps can patients take to minimize these risks? Following post-operative instructions carefully, attending all follow-up appointments, and participating in recommended physical therapy can help reduce the likelihood of complications.

Long-Term Outlook and Follow-Up Care After Collarbone Surgery

The long-term prognosis following collarbone surgery is generally positive. Most patients experience significant improvements in pain and function, with many returning to their pre-injury level of activity.

Regular follow-up appointments with healthcare professionals are essential to ensure proper healing. These appointments may include:

• X-rays to monitor bone healing
• Physical examinations to assess shoulder strength and range of motion
• Discussions about any ongoing pain or concerns
• Adjustments to rehabilitation plans as needed

How long should patients expect to have follow-up care? While the frequency of appointments may decrease over time, some patients may continue to have periodic check-ups for up to a year or more after surgery, depending on their individual healing progress and any complications.

Potential for Hardware Removal

In some cases, the hardware (plates, screws, or pins) used to stabilize the collarbone may need to be removed after the bone has healed. This is typically considered if the hardware causes discomfort or interferes with shoulder function.

When is hardware removal typically considered? Hardware removal is usually not considered until at least six months to a year after the initial surgery, allowing ample time for the bone to heal completely. The decision to remove hardware is made on a case-by-case basis, considering factors such as patient comfort, activity level, and the potential risks of a second surgery.

Lifestyle Considerations During Collarbone Surgery Recovery

Recovering from collarbone surgery requires some lifestyle adjustments to ensure optimal healing. Patients should consider the following factors during their recovery period:

• Sleep position: Sleeping in a reclined position or on the unaffected side may be more comfortable
• Clothing choices: Loose-fitting, button-up shirts may be easier to manage while wearing a sling
• Work accommodations: Depending on job requirements, patients may need to take time off or request modified duties
• Driving restrictions: Patients should not drive while wearing a sling or taking strong pain medications
• Exercise limitations: Gradually reintroducing physical activities under the guidance of a healthcare professional

How can patients maintain their overall health during recovery? Maintaining a balanced diet rich in nutrients that support bone healing, staying hydrated, and getting adequate rest can all contribute to a smoother recovery process.

The Impact of Smoking on Collarbone Surgery Recovery

Smoking can significantly impact the healing process after collarbone surgery. Tobacco use has been shown to:

• Slow down bone healing
• Increase the risk of complications such as infection
• Reduce the effectiveness of pain medications
• Impair overall recovery and return to function

What steps can smokers take to improve their recovery outcomes? Healthcare providers strongly recommend quitting smoking before surgery and maintaining abstinence throughout the recovery period. Smoking cessation resources and support should be discussed with healthcare professionals as part of the pre-operative planning process.

Advances in Collarbone Surgery Techniques

Surgical techniques for treating collarbone fractures continue to evolve, with new approaches aimed at improving outcomes and reducing recovery time. Some recent advancements include:

• Minimally invasive techniques: Some surgeons now use smaller incisions and specialized instruments to reduce tissue damage and scarring
• Improved fixation devices: New designs in plates and screws offer better stability and may reduce the need for hardware removal
• 3D printing technology: Custom-made implants based on a patient’s anatomy can provide a more precise fit
• Biological augmentation: The use of bone grafts or synthetic materials to promote faster healing in complex fractures

How do these advancements benefit patients? These innovations can potentially lead to faster recovery times, reduced risk of complications, and improved long-term outcomes. However, the suitability of these techniques depends on the specific nature of the fracture and individual patient factors.

The Future of Collarbone Fracture Treatment

Research in the field of orthopedic surgery continues to explore new ways to enhance collarbone fracture treatment. Some areas of ongoing investigation include:

• Gene therapy to accelerate bone healing
• Smart implants that can monitor healing progress
• Nanotechnology applications in fracture repair
• Virtual reality tools for surgical planning and patient education

While many of these technologies are still in the experimental stage, they hold promise for further improving the treatment of collarbone fractures in the future.

Making Informed Decisions About Collarbone Surgery

Deciding whether to undergo collarbone surgery requires careful consideration of various factors. Patients should engage in thorough discussions with their healthcare providers to make informed decisions about their treatment.

What questions should patients ask when considering collarbone surgery? Some important points to discuss include:

• The potential benefits and risks of surgery compared to non-surgical treatment
• The surgeon’s experience with the specific procedure
• Expected recovery time and return to various activities
• Long-term outcomes and potential for future complications
• Alternative treatment options, if any

Patients should feel empowered to ask questions and seek second opinions if needed. The goal is to make a decision that aligns with the patient’s overall health goals and lifestyle considerations.

The Importance of Patient Compliance in Recovery

The success of collarbone surgery and subsequent recovery largely depends on patient compliance with post-operative instructions and rehabilitation protocols. Adhering to these guidelines can significantly impact healing time and long-term outcomes.

How can patients ensure they’re following their recovery plan effectively? Some strategies include:

• Keeping a recovery journal to track progress and any concerns
• Setting reminders for medication schedules and exercise routines
• Regularly communicating with healthcare providers about recovery progress
• Enlisting support from family or friends to assist with daily tasks during the initial recovery period

By actively participating in their recovery process, patients can optimize their healing and potentially achieve better long-term results following collarbone surgery.

Collarbone surgery: Procedure, uses, and recovery

Collarbone surgery involves repairing a broken clavicle bone. Surgeons will try to realign the displaced bone and fix it in place to help it heal. People can usually return to their usual activities within 3 months.

The clavicle, or collarbone, sits on top of the rib cage in front of the chest. It provides support for shoulder movement.

A collarbone fracture often occurs due to a fall onto the shoulder or an outstretched arm. This type of fracture is common. About 5% of all adult fractures involve the collarbone. About 35%-45% of breaks in the shoulder area involve the collarbone.

After a collarbone fracture, doctors may recommend surgery. This article explores collarbone surgery, including what happens during the procedure, risks, and recovery.

Share on PinterestJessica Christian/The San Francisco Chronicle via Getty Images

Doctors may treat a collarbone fracture with or without surgery. In some cases, conservative treatment without surgery is an option. But in other instances, doctors recommend surgery.

The break can occur in the following places:

• In the middle of the collarbone, where the bone attaches to the shoulder blade or ribcage. This is the most common type of clavicle fracture.
• Near the acromioclavicular (AC) joint, where the clavicle meets the shoulder. This is the second most common type of fracture.
• Close to the sternum (breastbone). This is the least common type of break.

The need for collarbone surgery depends on the severity of the fracture. Sometimes, the bone may only crack. However, more serious fractures can result in the collarbone breaking into several pieces.

Collarbone surgery involves putting the bone back into the correct alignment, which promotes proper healing.

Doctors may recommend collarbone surgery in the following situations:

• A displaced fracture: This involves a break that moves the bone so much that it becomes misaligned. This fracture has an increased chance of complications, such as not healing well.
• An open fracture: This refers to a broken bone that breaks through the skin. An open fracture causes an increased risk of problems, such as infection.
• A non-healing fracture: Collarbone fractures may also involve nonsurgical treatments. However, about 30% of collarbone fractures treated without surgery do not heal properly. When a nonsurgical approach fails, surgery may become an option.

Learn more about the causes of collarbone pain.

Collarbone surgery aims to stabilize the broken bone, allowing it to heal in the correct position.

Surgery usually involves open reduction and internal fixation (ORIF) surgery. This is where surgeons realign the misplaced bones and then fix them in place with screws, pins, plates, or rods.

Typically, doctors perform the surgery under general anesthesia, which means a person is unconscious throughout the procedure.

ORIF surgery involves the surgeon:

1. applying antiseptic to the skin area, which helps prevent infection
2. making an incision in the skin and muscle near the collarbone
3. aligning and repositioning the pieces of bone
4. inserting plates, screws, or pins to hold the bones in place and improve shoulder strength

Learn more about bone fracture repair.

Anyone having surgery on their clavicle will receive specific instructions before the operation. This may include stopping certain medications for a time before surgery. However, a person should not stop taking medications until a healthcare professional has instructed them to do so.

Preparation may also include getting an X-ray of the collarbone to determine the severity of the bone misalignment.

Usually, before surgery, doctors order blood tests and an EKG to check for any abnormalities that may prevent the surgeon from operating safely.

Healing time after collarbone surgery can vary depending on someone’s overall health and lifestyle. For example, smoking tobacco may slow the healing process. Most people can resume regular activities about 3 months after the surgery.

During initial recovery, a person will wear a sling to keep the shoulder from moving. Pain levels may vary. But some pain is a natural part of the healing process. The doctor will advise how to manage pain during recovery.

A small patch of skin below the cut may feel numb. This may become less noticeable over time. Some people report feeling the plate that holds the bones in place.

A healthcare professional may also recommend physical therapy after an initial period of healing. Physical therapists can aid recovery by teaching people exercises to improve their range of motion and strengthen the shoulder.

Regular follow-up appointments with a healthcare professional are necessary to ensure the bone heals well.

Learn more about how broken bones heal.

The outcome of collarbone surgery is typically good. But it is not clear whether surgery leads to better overall healing.

This 2018 research involved a small study of 138 people with closed midshaft collarbone fractures. Of the participants, 69 had collarbone surgery, and 69 received nonoperative treatment.

The study found no differences in poor outcomes or complications between the group treated with surgery and the nonsurgical treatment group.

But other research has found that surgery provides a more favorable recovery than nonsurgical treatment. A 2022 systematic review and meta-analysis involved 3,094 people with a closed midshaft collarbone fracture. The study indicated that surgical treatment led to fewer complications and better long-term function than nonsurgical treatment.

Doctors might recommend nonsurgical treatment for a collarbone fracture if the bones are not significantly misaligned.

Treatment may include:

• wearing a sling to prevent the bone from moving while healing
• icing the area to reduce inflammation
• taking pain medication, such as acetaminophen (Tylenol), to relieve pain as the bone heals
• doing physical therapy to improve strength and range of motion

Learn more about how fractures heal here.

All surgery carries risks, including the risk of infection and excessive bleeding. Sometimes, the bone does not heal properly after collarbone surgery, which is known as non-union. However, the overall infection and non-union rate for collarbone surgery affect fewer than 4.5% of people.

A large number of nerves surround the collarbone. Nerve injury due to the surgery can occur but is uncommon.

Another possible risk involves discomfort from the pins, screws, or plates used to hold the bone in place.

Collarbone surgery involves the repair of a clavicle fracture. Not all collarbone fractures require surgery. But for an open or displaced fracture, healthcare professionals often recommend surgery.

Surgery involves putting the bone into the proper position and fixing it using pins, rods, screws, or plates to keep it in place.

Healing times vary, but people typically resume their usual activities within 3 months.

Collarbone surgery: Procedure, uses, and recovery

Collarbone surgery involves repairing a broken clavicle bone. Surgeons will try to realign the displaced bone and fix it in place to help it heal. People can usually return to their usual activities within 3 months.

The clavicle, or collarbone, sits on top of the rib cage in front of the chest. It provides support for shoulder movement.

A collarbone fracture often occurs due to a fall onto the shoulder or an outstretched arm. This type of fracture is common. About 5% of all adult fractures involve the collarbone. About 35%-45% of breaks in the shoulder area involve the collarbone.

After a collarbone fracture, doctors may recommend surgery. This article explores collarbone surgery, including what happens during the procedure, risks, and recovery.

Share on PinterestJessica Christian/The San Francisco Chronicle via Getty Images

Doctors may treat a collarbone fracture with or without surgery. In some cases, conservative treatment without surgery is an option. But in other instances, doctors recommend surgery.

The break can occur in the following places:

• In the middle of the collarbone, where the bone attaches to the shoulder blade or ribcage. This is the most common type of clavicle fracture.
• Near the acromioclavicular (AC) joint, where the clavicle meets the shoulder. This is the second most common type of fracture.
• Close to the sternum (breastbone). This is the least common type of break.

The need for collarbone surgery depends on the severity of the fracture. Sometimes, the bone may only crack. However, more serious fractures can result in the collarbone breaking into several pieces.

Collarbone surgery involves putting the bone back into the correct alignment, which promotes proper healing.

Doctors may recommend collarbone surgery in the following situations:

• A displaced fracture: This involves a break that moves the bone so much that it becomes misaligned. This fracture has an increased chance of complications, such as not healing well.
• An open fracture: This refers to a broken bone that breaks through the skin. An open fracture causes an increased risk of problems, such as infection.
• A non-healing fracture: Collarbone fractures may also involve nonsurgical treatments. However, about 30% of collarbone fractures treated without surgery do not heal properly. When a nonsurgical approach fails, surgery may become an option.

Learn more about the causes of collarbone pain.

Collarbone surgery aims to stabilize the broken bone, allowing it to heal in the correct position.

Surgery usually involves open reduction and internal fixation (ORIF) surgery. This is where surgeons realign the misplaced bones and then fix them in place with screws, pins, plates, or rods.

Typically, doctors perform the surgery under general anesthesia, which means a person is unconscious throughout the procedure.

ORIF surgery involves the surgeon:

1. applying antiseptic to the skin area, which helps prevent infection
2. making an incision in the skin and muscle near the collarbone
3. aligning and repositioning the pieces of bone
4. inserting plates, screws, or pins to hold the bones in place and improve shoulder strength

Learn more about bone fracture repair.

Anyone having surgery on their clavicle will receive specific instructions before the operation. This may include stopping certain medications for a time before surgery. However, a person should not stop taking medications until a healthcare professional has instructed them to do so.

Preparation may also include getting an X-ray of the collarbone to determine the severity of the bone misalignment.

Usually, before surgery, doctors order blood tests and an EKG to check for any abnormalities that may prevent the surgeon from operating safely.

Healing time after collarbone surgery can vary depending on someone’s overall health and lifestyle. For example, smoking tobacco may slow the healing process. Most people can resume regular activities about 3 months after the surgery.

During initial recovery, a person will wear a sling to keep the shoulder from moving. Pain levels may vary. But some pain is a natural part of the healing process. The doctor will advise how to manage pain during recovery.

A small patch of skin below the cut may feel numb. This may become less noticeable over time. Some people report feeling the plate that holds the bones in place.

A healthcare professional may also recommend physical therapy after an initial period of healing. Physical therapists can aid recovery by teaching people exercises to improve their range of motion and strengthen the shoulder.

Regular follow-up appointments with a healthcare professional are necessary to ensure the bone heals well.

Learn more about how broken bones heal.

The outcome of collarbone surgery is typically good. But it is not clear whether surgery leads to better overall healing.

This 2018 research involved a small study of 138 people with closed midshaft collarbone fractures. Of the participants, 69 had collarbone surgery, and 69 received nonoperative treatment.

The study found no differences in poor outcomes or complications between the group treated with surgery and the nonsurgical treatment group.

But other research has found that surgery provides a more favorable recovery than nonsurgical treatment. A 2022 systematic review and meta-analysis involved 3,094 people with a closed midshaft collarbone fracture. The study indicated that surgical treatment led to fewer complications and better long-term function than nonsurgical treatment.

Doctors might recommend nonsurgical treatment for a collarbone fracture if the bones are not significantly misaligned.

Treatment may include:

• wearing a sling to prevent the bone from moving while healing
• icing the area to reduce inflammation
• taking pain medication, such as acetaminophen (Tylenol), to relieve pain as the bone heals
• doing physical therapy to improve strength and range of motion

Learn more about how fractures heal here.

All surgery carries risks, including the risk of infection and excessive bleeding. Sometimes, the bone does not heal properly after collarbone surgery, which is known as non-union. However, the overall infection and non-union rate for collarbone surgery affect fewer than 4.5% of people.

A large number of nerves surround the collarbone. Nerve injury due to the surgery can occur but is uncommon.

Another possible risk involves discomfort from the pins, screws, or plates used to hold the bone in place.

Collarbone surgery involves the repair of a clavicle fracture. Not all collarbone fractures require surgery. But for an open or displaced fracture, healthcare professionals often recommend surgery.

Surgery involves putting the bone into the proper position and fixing it using pins, rods, screws, or plates to keep it in place.

Healing times vary, but people typically resume their usual activities within 3 months.

Clavicle Fracture – Physiotherapist

Clavicle fractures are very common in adults (2-5%) and children (10-15%) and account for 44-66% of all shoulder girdle fractures. This is the most common fracture among pediatric patients. Most often, a clavicular fracture is caused by a fall on the lateral side of the shoulder. X-rays confirm the diagnosis and help in further examination and treatment. While most clavicle fractures are treated conservatively, severely displaced or comminuted fractures may require surgical fixation [1].

Contents

Clinically relevant anatomy

The clavicle lies under the skin between the sternum and shoulder blade and connects the upper limb to the body. [1]

The clavicle, the first of the bones in the human body, begins to ossify in the connective tissue membrane directly from the mesenchyme as early as the fifth week of fetal life. Like all tubular bones, the clavicle has both a medial and a lateral epiphysis, but lacks a distinct medullary cavity. The epiphyseal plates of the medial and lateral epiphyses of the clavicle do not fuse until the age of 25. The clavicle differs from tubular bones in its characteristic S-shaped double curvature, convex in the medial direction and concave in the lateral direction. This shape allows the clavicle to serve as a support for the upper limb, as well as to protect the axillary vessels and the brachial plexus and ensure their passage from the medial side. [2]

Etiology

Young patients suffer fractures due to moderate or high-energy injuries such as car accidents or sports injuries, while older people suffer from low-energy falls.

Traditionally, the cause of the fracture was considered to be a fall onto an outstretched arm, but it has been found that most often the clavicle is injured as a result of applying a direct compressive force directly to the shoulder. [2] Approximately 87% of clavicle fractures result from a fall directly on the lateral side of the shoulder. [1

Mechanism of injury.

1. Fall on a straight arm.
2. Shoulder drop.
3. Direct blow to the shoulder.

Epidemiology

Clavicle fractures account for 2% to 10% of all fractures. Clavicle fractures [1]

• Found in 1 in 1000 people per year
• Are the most common fractures among pediatric patients
• Approximately two thirds of all clavicle fractures occur in men.
• There is a bimodal distribution of clavicle fractures, with 2 peaks occurring in men under 25 years of age (sports injuries) and patients over 55 years of age (falls).
• The middle third of the clavicle breaks in 69% of cases, the distal third in 28%, and the proximal third in 3%. [1]
• They account for up to 10% of all sports-related fractures and have the third longest return to sport, with up to 20% of athletes with such injuries not returning to sport. [3]

The clavicle is the only bony link between the upper limb and the trunk Due to its superficial subcutaneous location and the numerous ligamentous and muscular forces applied to the clavicle, this bone breaks easily. The middle third of the clavicle is the thinnest area that does not have ligamentous attachments, so its fractures are most likely. [1]

Classification

Clavicle fractures are usually described according to the Allman classification system, which divides fractures into 3 groups based on location. The system was later revised by Nier (Group II was further classified into 3 types). [1

1. Group I: Fractures in the middle third of the diaphysis (most common),
2. Group II: Fractures of the distal or lateral third. Frequent site of nonunion.
3. Group III: Fractures of the proximal or medial third.

The Robinson classification was more specific for different types of fractures in the middle third, while the Craig classification was for fractures of the lateral third. [4]

Clinical History and Physical Examination

The patient has the following symptoms and signs:

• The patient can hold the injured limb with a healthy hand.
• Patient may report clicking or popping sound when injured.
• The shoulder may appear to be shortened relative to the opposite side and lowered.
• There may be swelling, ecchymosis, and tenderness over the clavicle.
• An abrasion over the clavicle may be noted, indicating that the fracture occurred by a direct mechanism.
• With careful manipulation, the sound of crepitus can be noted from the friction of the ends of the fracture against each other.
• Labored or weak breathing on the affected side may indicate lung injury, such as pneumothorax.
• Palpation of the scapula and ribs may reveal associated lesions.
• Stretching and pallor of the skin at the fracture site may indicate an open fracture, which most often requires surgical stabilization.
• Non-use of the hand of the affected side is a neonatal manifestation.
• Associated distal nerve dysfunction indicates damage to the brachial plexus.
• Decreased heart rate may indicate damage to the subclavian artery.
• Venous congestion, discoloration and swelling indicate subclavian vein damage. [5]

Differential diagnosis

Diagnosis is based on the patient’s history and physical examination.[6]

The differential diagnosis of a clavicle fracture includes acromioclavicular joint injury, rib fractures, scapular fracture, shoulder dislocation, rotator clavicle injury, and sternoclavicular joint injury.

The potential complications of clavicle fractures, including pneumothorax, brachial plexus injury, and subclavian vessel injury, should also be fully assessed. [1]

Depending on the severity of the clavicle fracture, laboratory tests are ordered. If vascular damage is suspected, a general clinical blood test (CBC) should be performed to check hemoglobin and hematocrit values. If lung injury is suspected or detected, an arterial blood gas test and an exhaled posterior-anterior chest x-ray should be performed. Imaging studies are also performed to evaluate a clavicle fracture, such as:

• Clavicle and shoulder X-ray
• Computed tomography (CT) with 3-dimensional (3-D) reconstruction
• Arteriography
• Ultrasound scanning [5]

Medical treatment

Fracture of the clavicle is treated surgically or conservatively depending on the location (middle, distal, proximal), nature (displaced, non-displaced, comminuted) of the fracture, the presence of open or closed injury, age and neurovascular disorders. [3]

Traditionally, clavicle fractures have been treated conservatively with immobilization with a bandage and subsequent rehabilitation. For non-displaced fractures, such treatment gives satisfactory results, but for fractures of the middle part of the clavicle with displacement, it leads to an increase in the likelihood of re-injury, time to return to sports and the development of suboptimal shoulder function secondary to malunion and shortening of the clavicle with subsequent scapular thoracic dyskinesia. It has also been shown that conservative treatment of lateral displaced fractures in an athlete results in high rates of nonunion and subsequent impairment of shoulder function.

Thus, surgery is performed for lateral fractures with displacement in athletes, and is also recommended for fractures of the middle third of the diaphysis with complete displacement, shortening > 2 cm, or the presence of splinters. [3]

Surgical treatment

The main goal of this treatment is to achieve fusion of the clavicle in a normal anatomical position.

Indications for surgical treatment of clavicle fractures: [7]

1. Severe displacement caused by crushing followed by angular bending and severe stretching of the skin, threatening its integrity, and in the absence of a response to closed reduction.
2. Symptomatic nonunion such as shoulder girdle dysfunction, neurovascular disorders.
3. Neurovascular injury or impairment that progresses or does not recover after closed fracture reduction.
4. Open fracture.
5. Type II distal clavicle fracture (displaced).
6. Multiple injuries where mobilization is desired and closed methods of immobilization are not practical or possible.
7. “Floating shoulder”
8. Inability to tolerate closed immobilization, eg neurological problems of parkinsonism, convulsive disorders.
9. Aesthetic reasons
10. Relative readings include shortening of more than 15-20 mm and displacement of more than the width of the clavicle.

Surgical procedures include:[8]

• Internal fixation with plates and screws. (most common)
• Intramedullary (IM) fixation.

For displaced fractures of the middle shaft, removal of metal structures is recommended if intramedullary nails are used, but not fixation plates. While in case of a lateral fracture of the clavicle with a displacement, the removal of metal structures was carried out with fixation with a hook-shaped plate, rods, cerclage and tie wire, but not with fixation with plates that did not capture the ACJ, and with a suture. These methods of fixation are necessary for a lateral fracture of the clavicle, as they capture the acromioclavicular joint and various ligaments that can be damaged during a fracture. [3]

Physical Therapy / Rehabilitation

The main goal of rehabilitation is to improve and restore the function of the shoulder for everyday, professional and sports activities. The rehabilitation protocol may differ slightly in the first few weeks depending on the main approach to treatment, i. e. conservative or surgical.

Rehabilitation after conservative treatment

Non-operative treatment may take longer for fractures to heal. With conservative treatment, midshaft clavicle fractures usually heal between 18 and 28 weeks after injury. Therefore, it is necessary to regularly check whether the fracture site heals correctly or not. Thus, the rehabilitation protocol may also vary depending on individual comorbidities.

In the first few weeks (2-4 weeks) of an acute clavicle fracture, the POLICE principle can be used, which is explained below in the context of a clavicle fracture.

Protection

The patient’s shoulder is immobilized in a bandage or 8-band until clinical union is achieved. It is believed that the 8-bandage prevents or reduces the secondary shortening of the fracture during its healing. But it is associated with great discomfort and pain, including nerve compression with temporary paralysis of the brachial plexus and obstruction of venous blood return. [9]]Studies have shown that in the treatment of clavicle fractures, there is no difference between the two methods in terms of healing time and percentage of nonunions. Thus, a brace is commonly used, and immobilization in internal rotation for 2-4 weeks is recommended.[9] [1] The bandage is worn during the day, except for exercise and personal hygiene. The patient independently decides to leave it at night or not, but care should be taken. [9]

During severe coughs and sneezes, patients should also be careful (since respiratory excursions can cause collarbone movement) to avoid them as much as possible, and to learn active-passive coughing techniques.

Optimal loading

Therapy/Consultation within 1-2 weeks after injury:

• Use of a shoulder brace as mentioned above (must be worn most of the time).
• Self-mobilization is required to avoid stiffness of the elbow and wrist joints several times a day.
• Raising the elbow above shoulder height may be painful.
• During the first 1-2 weeks, the development of the range of motion of the shoulder is limited to pendulum exercises.
• Teaching correct neck position and range of motion.

Therapy/Counseling 3 to 6 weeks after injury:

• Decreased bandage wear time (use in independent position).
• Return to light daily activities using the arm and shoulder.
• During the first 6 weeks, active-passive movements in the shoulder joint are recommended with an amplitude of active movements in one plane with a deviation of no more than 90 degrees.
• Scapular mobilization exercises are included.
• Isometric Shoulder Exercise with Tolerable Resistance Starting at 4-6 weeks
• Heavy exercise should be avoided for a full 6 weeks.
• A gradual increase in the intensity of cardiovascular endurance training can begin with a brisk walk and a stationary bike.

Therapy/Consultation between 6 and 12 weeks after injury:

• As a rule, after 6 weeks with tolerable passive BP, active and active-passive range of motion of the shoulder in all planes is allowed.
• Progressive resistance exercises (isotonic) for the stabilizing muscles of the scapula, biceps, triceps, and rotators are given after 6 weeks.
• Arm stress should be avoided until clinical healing of the fracture.
• Sports and activities that require arm loading and use are usually suspended until pain subsides and radiological signs of progressive fracture consolidation are obtained, usually after 6 to 12 weeks.

Therapy/Counseling after 12 weeks or more:

Start a more intense strengthening program, cardiovascular endurance training as tolerated, and progressive athletic training.

• The period of return to specific sports is determined by the physiotherapist using functional tests based on the needs of the patient, according to which a specific progressive sports training is planned.[12]
• Preliminary activities such as muscular endurance exercises (upper body ergometer) and cardiovascular endurance exercises (treadmill, cycling) may be prescribed.
• Contact sports should be avoided for 3-4 months. Returning to full contact sports requires that the athlete demonstrate radiological evidence of bone healing, no tenderness to palpation, full range of motion, and normal shoulder muscle strength [9][1].

Rehabilitation after surgery

• For fractures of the middle third of the clavicle, the initial open reduction with internal fixation with a plate (fixation compression plate) and screws provides more stable fixation and immediate postoperative mobilization. [7] With surgical treatment, fractures heal faster than with conservative treatment. Thus, the duration of immobilization is shorter compared to conservative treatment, and mobilization and strengthening exercises can be prescribed earlier. A program similar to conservative treatment to increase the intensity of exercise can be prescribed, but much earlier.

Return to sports

According to a systematic review by Robertson and Wood in 2016, most patients with acute clavicle fractures return to sports, with about four-fifths of all patients able to return to their pre-injury level of sports activity. [3]

Studies have shown that the period to return to sport is from 6 to 12 weeks with surgery and 3-4 months with conservative treatment. [3] [1]

Conservative treatment of displaced midshaft fractures has been shown to reduce the percentage and increase the time to return to sport compared with surgery. Conservative treatment of displaced midshaft fractures can lead to re-fracture (more than half of cases) and delayed surgery (more than a quarter of cases). In terms of surgical technique recommendations for midshaft fractures, both plate fixation and intramedullary screws demonstrated nearly 100% recovery and similar recovery times. [3]

For lateral displaced clavicle fracture, surgical management is standardized and shows an increase in percentage and a reduction in return time. Non-ACC plate fixation and suture fixation provide better outcomes for athletes than other methods of fixation, which is likely due to preservation of ACC function. A lateral fracture of the clavicle is more difficult than a fracture of the middle shaft, so the outcome of the latter is better. [3]

Conclusion

• Patients with collarbone fractures are best referred to an interprofessional team that includes an orthopedic surgeon, an emergency room physician, a general practitioner, a nurse practitioner, and a physical therapist.
• Immediate orthopedic consultation should be performed for patients with neurovascular disease, open fractures, skin stretch, or any skin tear near the fracture.
• For non-displaced fractures, non-surgical treatment is the first choice.
• While surgical treatment is generally accepted for lateral displaced fractures in athletes and is recommended for midshaft displaced fractures. Surgical treatment results in improved percentage and time of return compared to conservative treatment. [3]
• Fracture healing may take 8-12 weeks with a good outcome for most patients. However, some patients may experience chronic pain and limited range of motion of the shoulder joint. [1]
• In acute cases and cases of postoperative nonunion, an early mobilization rehabilitation protocol may be recommended [11].

rehabilitation after fractures, injuries, restorative and sports medicine

Forward

• Rehabilitation after spinal injury and spinal surgery
• Recovery after complex injuries of bones, ligaments, joints
• Recovery after joint surgery, after endoprosthetics

• Rehabilitation after prolonged hospitalization, limb immobilization
• Rehabilitation of children with scoliosis and postural disorders
• Rehabilitation of children with cerebral palsy

• Recovery of children with degenerative-dystrophic diseases of the musculoskeletal system: hyperplasticity, instability of joints and ligaments, clubfoot, turned feet, unstable posture and walking, valgus-varus deformity of the feet, X-shaped, O-shaped legs

• Recovery from emotional and physical burnout syndrome, chronic fatigue
• Special programs for men
• Special programs for women 40+

• Rehabilitation of professional athletes: sports injury recovery, injury prevention, rapid recovery after surgery
• Special energy recovery programs for IT professionals

60

patents

The center uses Dr. Bloom’s original technique. The system of methods, techniques and special equipment has 60 patents.

Recovery after surgery

Recovery programs

Recovery programs after injuries and operations, general health improvement and active longevity, anti-stress and detox programs.

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Rehabilitation of children

Rehabilitation programs

Rehabilitation programs for cerebral palsy, scoliosis and posture disorders, programs for the improvement of children from birth.

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Recovery of athletes

Recovery programs

Athletes come to us
to recover from injuries and prolong their professional careers, prepare for upcoming competitions, reach a new level of sporting achievements.

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Restoration of body geometry

Restoration of tissue structure

Elimination of adhesions

Improvement of blood flow

Training of coordination, strength and endurance

Restoration of movement in the joints

Strengthening of the muscles of the core

9 0002 Improvement of neurotrophic and neuroregulation

Elimination of muscle and joint contractures

Forward

Over

50

Forward

Start
medical career
.

Start of work on the recovery of
athletes and patients
with serious illnesses
in Israel, France, USA,
England and Turkey.

Establishment of the Research Institute of Clinical Rehabilitation, development of author’s scientific directions, methods, techniques and special equipment.

Professor Blum headed the Department of Clinical Rehabilitation of the Peoples’ Friendship University of Russia.

Dr. Blum Center opened in Moscow.

Dr.
Bloom Center opened in Marbella.

Reviews

Forward

Feedback from Natalia. Bronchial asthma. Emphysema of the lungs.

Recovery results

Feedback from Venera Akhmatovna, 80+, Active longevity

Recovery process

Fracture of the right humerus

Recovery process

Evgeny Sivozhelez
Russian volleyball player,
five-time champion of Russia

Injury prevention and recovery after injury

Mikhail Youzhny, tennis player,
two-time Davis Cup winner

Preparation for sports competitions

Yuri Berezhko, volleyball player,
Olympic champion

Rehabilitation after a knee injury

Sofia Zhuk, tennis player,
Wimbledon 9 winner0377 tournament 2015

Prevention of sports injuries

Alena Sviridova,
singer and composer

General health program

Petr Osipov, Founder
of the Business Youth project

90 002 Recovery from burnout syndrome

Gennady Burbulis,
Russian State
and public figure

About Dr. Blum Center

Sergey Krikalev, Soviet
and Russian aviation
athlete and cosmonaut

About Dr. Blum’s Center

Alexander Volchek

Recovery from burnout syndrome

Sergey Surov

Recovery after a severe spinal injury

Pelageya’s mother Mishal

Rehabilitation child with cerebral palsy

Father of boys
Gregois and Foucault Dogni

Rehabilitation of children with hydrocephalus and developmental delay in cerebral palsy

Patient of Dr. Blum’s
center

Recovery in ankylosing spondylitis

Ivan

Rehabilitation of a hernia of the lumbar spine and scoliosis

Mother of Mark Patrikeeva

Rehabilitation of a child with arthrogripposis

Mother of Vlad Inozemtsev

Rehabilitation of Duchenne myopathy a

Nikolai

Rehabilitation of a severe combined injury of the lower limb

Boris

Recovery after surgery to remove a herniated disc

Elena Spir

Recovery after a compound fracture of the collarbone

«

Everything is fixable as long as you are ready to work.

”

Evgeniy Blum — author of the system of methods, techniques and specialized equipment Blum, professor, doctor of medical sciences, honored inventor of Russia in the field of biomechanical methods of restoring health.

The core areas of the center’s work are: rehabilitation after injuries and operations, pathologies of the musculoskeletal system in children and adults, preparation for sports competitions and injury prevention.

The method is aimed at launching the natural mechanisms of healing, regeneration and cleansing through a targeted effect on the deep muscle layers.

Our task is to find the weak links in the body, unravel the tangle of cause-and-effect relationships of the disease and restore the health resource step by step. The mission of the center is active longevity without drugs and operations.

Patent No. 141828

Massage Device

Patent No.

141826

Muscle Correction Device

90 352 Patent No. 141961

Device for correcting muscle…

Patent No. 2255784

Recovery device…

Patent #2281733

Recovery device…

Patent no. 003

Patent No. 2124877

Device for the elimination of contractures

Patent No.

Patent No. 21

Muscle Correction Device

Patent No. 2207102

Method for the treatment of diseases associated with…

Patent no. 2 Apparatus for the elimination of contractures

Certificate No. 1014

Corrective correction device…

Patent no.0003

Patent No. 51876

Perineal massage device 03

Patent No. 2189214

Back massage method and device for…

Patent No. 2205617

Obstetric bandage for…

Patent no.

Patent no. 2286823

Child rehabilitation trainer

License LO-77-01-006109

For medical…

License LO-77-01-006109

Second page

License LO-77-01-006109

Annex to license

0377 activity

License for
physiotherapy
activity

news

Book by Alexander Nikonov

Alexander Nikonov in his book “The Doctor Who Learned to Treat Everything” describes Dr. Blum’s method as effective for all conditions and diseases.

25/06

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Doctor’s article

Connective tissue dysplasia. Analysis of the professor, d.m.s. Evgeniya Bluma

Video analysis of the medical history of a 42-year-old woman. Biomechanical diagnosis: Damage to the connective tissue at the organismal level. Connective tissue dysplasia in the polymorphism of manifestations.
To understand the depth of analysis, the energy-economics of the process, the mechanisms of manifestations and the recovery technique, it is advisable to watch the video to the end.